Puberty
Define precocious puberty in girls (age)
Onset of pubertal signs prior to the age of 8
What hormones are secreted by the pituitary gland?
FSH (follicle stimulating hormone)
LH (Luteinizing hormone)
ACTH (adrenocorticotropic hormone)
GH (growth hormone)
TSH (Thyroid stimulating hormone)
Prolactin
ADH (antidiuretic hormone)
Oxytocin
What are the 2 types of GH deficiencies?
Acquired (due to damage)
-brain tumors, radiation, head trauma, infections of CNS
Congenital (Present at birth due to a dysfunction of the pituitary gland)
-genetic mutations, abnormal development of pituitary gland, brain defects
What causes DI?
Deficiency of ADH (anti diuretic hormone)
What laboratory values might you expect to find in patients with hypothyroidism?
TSH elevated (to help raise the T3 and T4)
Low T3 and T4
Treatment of type 1 diabetes vs type 2 diabetes?
Insulin and diet (type 1)
Lifestyle changes and oral medications typically (type 2)
Butterfly rash is commonly seen in what autoimmune disorder?
Lupus (SLE)
Define precocious puberty in boys (age)
Onset of pubertal signs prior to the age of 9
Signs of hyperpituitarism in children
Excessive GH (very rare)-large birth size, rapid growth, enlarged hands and feet
Excessive ACTH (poor weight gain but moon face), high bp, hypergylcemia, poor wound healing
Excessive TSH (rare) signs of hyperglycemia like tachycardia, irritability, poor weight gain
Excessive LH/FSH (precocious puberty)
How is a child diagnosed with Growth Hormone Deficiency?
Growth patterns
Xrays of hands and wrists
Blood tests for Growth Hormone Factor and GH simulation
What are the 2 types of DI?
Central
Nephrogenic
*causes/signs and symptoms on next questions
What laboratory values might you expect to see in HYPERthyroidism?
Low TSH
Elevated T3 and T4
Define this: autoimmune destruction of insulin producing beta cells leading to insulin DEFICIENCY is found in which type of diabetes?
Type 1 diabetes
Name 5 components of the immune system (think organs)
Thymus
Tonsils
Adenoids
Lymphatic system
Bone marrow
Define delayed puberty in girls (age)
No signs of puberty by the age of 13
Signs of Hypopituitarism in infants and children?
Growth Hormone deficiency (poor feeding)
ACTH deficiency (hypoglycemia, lethargy, low bp).
TSH deficiency (prolonged jaundice, sleepiness)
LSH/FSH deficiency (micropenis, cryptorchidism)
ADH deficiency (excessive UOP, dehydration)
What is ACTH and its role?
Adrenocorticotropic Hormone
"stress regulator"
Stimulates adrenal gland to release cortisol
Regulates BP, blood sugar, metabolism
What causes Central DI? (name 2)
brain surgery
brain malformation
tumor
genetic disorders
head injury
encephalitis
meningitis
What is the most common type of hyperthyroidism?
Graves disease
antibodies stimulate the TSH receptor causing an overproduction
DKA is typically seen in Type 1 or Type 2 diabetes?
Type 1
What is Juvenile Idiopathic Arthritis (JIA)?
Autoimmune disorder in which the immune system mistakenly attacks the lining of the joints causing inflammation
Most common autoimmune disease in children
Define delay in puberty in boys (age)
Delay in puberty signs by the age of 14
How many lobes are in the pituitary gland?
2 (anterior and posterior)
What is the most common form of hormone deficiency found in children?
Growth Hormone Deficiency
What causes nephrogenic DI
Medications such as lithium, genetic disorder, kidney disease or hypercalcemia
*Kidneys fail to respond to ADH appropriately
What are the 2 signs of hyperthyroidism AND 2 signs of hypothyroidism?
HYPER:
irritability, feeding issues,
hypertension, tachycardia, goiter,
sleep disturbances, hyperactivity, heat intolerance,
weight loss, tremors, palpitations
HYPO: (low and slow)
hypotonic, jaundice, poor feeding, constipation,
dry skin, bradycardia, hypotension, hair loss, cold
Define this: Insulin resistance and impaired beta cell function is found in what type of diabetes?
Type 2 diabetes
What is the diagnostic criteria for JIA?
Arthritis begins before ate 16
Arthritis in one or more joints
Symptoms are present for at least 6 weeks
No single test to confirm (will draw things like ESR, CRP, ANA, Rheumatoid factor)
Can do things like X-rays, ultrasound and MRI to evaluate for inflammation or other causes of pain
How do we treat precocious puberty and delayed puberty?
Precocious: hormone blockers
Delayed: Testosterone and estrogen
This occurs if the pituitary gland secretes TOO much ACTH?
Cushings Disease
(Adrenal glands overproduce cortisol)
What is the role of prolactin hormone?
Breast milk production
How do we treat DI?
Thiazide diuretics
A low-solute diet
Close monitoring of Intake and Output
DDAVP if it is central
What are the 4 types of hypothyroidism and the causes?
Acquired hypothyroidism (immune system attacks the thyroid)
Congenital (developmental issues in the thyroid)
Iatrogenic (thyroid glad is medically destroyed)
Central (lack of TSH secreted by the pituitary gland)
Symptoms: Increased thirst (Polydipsia), increased urination (Polyuria), increased hunger (polyphagia) and weight loss are signs of what?
Type 1 diabetes
What is Methotrexate used for?
Disease modifying agent
Suppresses the overactive immune system and decreased inflammation
Can be used in JIA and Lupus
Can also be used in ectopic pregnancies (stops the dividing pregnancy tissue from growing)
What is the first sign of puberty in girls typically?
Breast buds
Name the 2 hormones stored in the posterior pituitary
Antidiuretic (ADH)
Oxytocin
What is the role of Follicle Stimulating Hormone? (FSH)
Stimulates sperm production
Stimulates the ovaries to produce estrogen/produce eggs
What is the function of Antidiuretic Hormone?
Helps the body to regulate water (these patients will dump large amounts of very diluted urine)
In DI the patient cannot preserve water
Dump large amounts of diluted water
Treatment of hypothyroidism
Levothyroxine
VERY important for babies (must treat early to prevent brain damage-preferably prior to 2 weeks of age)
What are the signs of DKA?
Extremely high blood sugar
Metabolic acidosis
Ketosis
Common signs of JIA
Joint pain
Swelling of one or more joints
Morning stiffness
Limping (especially in the mornings)
Warm joints (not always red)
Fatigue
What is the first sign of puberty in boys typically?
Testicular enlargement
Name 2 hormones that are secreted by the anterior portion of the pituitary gland
Adrenocorticotrophic Hormone (ACTH)
Follicle Stimulating Hormone (FSH)
Growth Hormone (GH)
Luteinizing Hormone (LH)
Prolactin
Thyroid Stimulating Hormone (TSH)
What is the role of Oxytocin?
Helps labor progress by signaling the uterus to contract
What are the signs of DI?
Excessive urine output (polyuria)
Excessive thirst (polydipsia)
Dehydration
High sodium
Low specific gravity of urine
Treatment of hyperthyroidism
Methimazole, may need radioactive
iodine, or surgery
Hyperglycemia hyperosmolar state is typically seen in which type of diabetes?
Type 2
What cells are infected in HIV and/or AIDS?
CD4 cells
these are a subset of the T cells